Whitening

Question 1

Stain

Answer 1

• intrinsic: chemical tooth bleaching, restorative crowns, veneers, or composites
• extrinsic: foods (coffees, teas, wines); drugs (chlorhexidine); habits (tobacco, betel leaf) - remove stain with self care, DH therapy, whitening
• combination

Question 2

Prior to Eruption

Answer 2

• fluoride
• tetracycline
• developmental

Question 3

After Eruption

Answer 3

• aging
• restorative materials
• secondary dentin/occlusal wear

Question 4

Non-Vital Tooth Whitening

Answer 4

-endodontically with internal bleaching

Question 5

Vital Tooth Whitening

Answer 5

-professional
  15-35% hydrogen peroxide
  35-44% carbamide peroxide
-professionally-dispensed at-home bleaching
-OTC products

Question 6

OTC

Answer 6

• strips 2 times/day for 30mins for 2 weeks
• pre-fabricated trays worn 30-60mins daily for 5-10 days
• paint-on carbamide peroxide incorporated into thick gel painted on selected teeth
• dentifrice in toothpaste, little effect on staining, some contain hydrogen peroxide
• mouthrinse contain agents that may deter further attachment of stains to the teeth, content of alcohol avoided

Question 7

Hydrogen Peroxide

Answer 7

• strong oxidizing agent, breaks down into oxygen and water
• oxygen ions break the bonds of the stain molecules into smaller, more soluble molecules
• 15-35% concentration

Question 8

Carbamide Peroxide

Answer 8

• peroxide breaks down into hydrogen peroxide and urea
• urea may further break down into ammonia with high pH to facilitate bleaching
• research supports that a neutral solution, 10%, safe and effective as bleaching agent

Question 9

Additional Ingredients in Whitening Systems

Answer 9

• desensitizers: potassium nitrate, sodium fluoride, calcium phosphate
• carbopol: water-soluble resin used as thickening agent
• glycerin: gel to thicken and control flow
• sodium hydroxide: chemical base
• flavoring

Question 10

Contraindications

Answer 10

• teeth that are acceptable shade
• teeth with restorations or decay
• patients who are photosensitive
• pregnant, lactating women
• exposed cementum or dentin

Question 11

Prior to Whitening

Answer 11

-determine initial shades
-document with digital image/photo
-debride and polish
-pretreatment desensitization
anti-inflammatory pain medication
fluoride treatment
-plain for maintenance and follow up

Question 12

Side Effects

Answer 12

-tooth sensitivity
-soft tissue irritation
-irreversible tooth damage
root resorption
tooth fracture
-effects on dental materials
-demineralization
-accidental ingestion of small amounts can cause sore throat, nausea, vomiting, abdominal distention, ulcerations of oral mucosa, esophagus, stomach

Question 13

Intrinsic Stains Resistant to Whitening

Answer 13

• tetracycline

- fluorosis

Question 14

DH Interventions

Answer 14

• first 24-48 hours after procedure critical due to loss of tooth moisture
• white instead of red wine
• cappuccine instead of espresso
• grapefruit instead of cranberry
• use straw
• rinse with water after consumption of staining foods